by Stephanie Eckelkamp
There’s a false narrative that tick-borne diseases aren’t much of a problem in southern states, but we know this to be far from the truth. Not only is Lyme disease present, but ailments like Heartland virus, ehrlichia, and Rocky Mountain spotted fever can be a big problem for people and pets — so it’s important to keep yourself protected.
One primarily southern tick-borne pathogen that’s gotten very little attention is STARI (southern tick-associated rash illness). STARI has caused confusion among doctors and patients because some of its early symptoms closely mimic those of Lyme disease. The promising news: STARI appears to be far less detrimental to long-term health than Lyme.
Here, we cover the signs and symptoms of STARI, how it differs from Lyme, what ticks carry it, and how to protect yourself.
What Is STARI?
STARI is an emerging zoonotic disease transmitted by the bite of the Lone Star tick, which often results in a red, ring-like rash with a central clearing that is almost indistinguishable from the erythema migrans bullseye rash sometimes seen in Lyme disease. The exact causative pathogen is still up for debate — while it was once thought to be caused by the Borrelia lonestari spirochete bacterium, this spirochete has not been detected in all cases of the illness.
Where Is It Most Commonly Found?
STARI isn’t a reportable condition, meaning it’s not required to be reported to public health agencies at local, state, or national levels. Therefore, it’s hard to get a clear breakdown of where exactly STARI is most concentrated, plus it may be misdiagnosed as Lyme. But in general, you can expect to find it where you’d discover Lone Star ticks — throughout south-central, southeastern, and eastern states.
While these ticks may be more concentrated in the south, their range spans eastward from central Texas and Oklahoma and up the Atlantic coast as far north as Maine. And scientists believe they’ll only get more common in northern states as global temperatures rise.
What Are the Symptoms?
A key feature of STARI is the red, ring-like rash with a central clearing surrounding the area of a tick bite. This rash usually appears within a week of the tick bite and may expand to three inches in diameter or more. The STARI rash is generally smaller, more circular, and less tender than a Lyme disease rash (which can reach 12 inches in diameter). Keep in mind that the saliva of Lone Star ticks can irritate the skin, so redness and discomfort aren’t always signs of infection. Nevertheless, any skin irritation after a tick bite is always worth monitoring.
Other symptoms of STARI may include:
- Muscle aches
- Joint pain
Fortunately, no long-term symptoms related to STARI have been reported, and the tick-borne illness hasn’t been associated with arthritic, cardiac, or neurologic manifestations in patients.
STARI vs. Lyme: What Are the Key Differences?
While there is clearly a lot of overlap between the symptoms of STARI and the early symptoms of Lyme disease, data suggests patients with STARI are less likely to experience neck stiffness, joint stiffness, and swollen lymph nodes than patients with Lyme, as well as the more severe symptoms mentioned above. Additionally, a study from 2005 comparing STARI patients in Missouri to Lyme disease patients in New York noted several other differences:
- STARI patients were more likely to recall a tick bite than Lyme patients.
- The time from tick bite to rash onset was shorter in STARI patients (approximately six days).
- STARI patients with a rash were less likely to have other symptoms.
- STARI patients were less likely to have multiple skin lesions than Lyme patients, and (as mentioned above) they tended to have rashes that were smaller and rounder.
- STARI patients recovered more rapidly after antibiotic treatment than Lyme patients.
How Is It Diagnosed and Treated?
Because scientists haven’t actually determined the exact causative agent (e.g., whether it stems from a bacterium, virus, parasite, etc.) that leads to STARI, diagnostic tests have not been developed. Doctors typically use a patient’s symptoms, geographic location, and the possibility of a tick bite to make a diagnosis. Of course, due to the fact that there is significant overlap in the symptoms of STARI and Lyme disease, there’s a real possibility for misdiagnosis.
It’s unknown whether antibiotics help treat STARI, but because this illness so closely resembles early Lyme, doctors often prescribe them to be safe. To date, STARI symptoms have resolved following oral doxycycline treatment, but it’s uncertain if the drugs do anything to speed recovery.
How to Protect Yourself
You certainly want to do what you can to protect yourself from the bite of a Lone Star tick. In addition to STARI, these ticks are known to transmit ehrlichiosis, Heartland virus disease, Bourbon virus disease, and tularemia. The bite of a Lone Star tick can also sometimes lead to alpha-gal syndrome, a potentially life-threatening allergic reaction to red meat.
Lone Star ticks are known to aggressively target and bite both humans and pets. So taking steps to protect yourself and to prevent them from hitching a ride into your home on Fido is key.
Some good strategies:
- Wear protective clothing when out in nature and shower afterward
- Avoid brushy areas and stay on the trail when hiking
- Perform regular tick checks
- Use an effective tick repellent, featuring essential oils like oil of lemon eucalyptus or insecticides such as DEET, picaridin, or permethrin.
If you get bitten, remove the tick promptly and carefully, following the steps in this article. If you save the tick, you might want to consider sending it to a laboratory such as IGenex or Ticknology to be tested for pathogens.
Pets should be subject to frequent tick checks, too, and you should strongly consider putting your dogs on some type of oral tick-preventative treatment. (Read this article for veterinary-approved tips on protecting your pets from tick-borne pathogens.)
STARI is a tick-borne illness that closely resembles early Lyme disease, but fortunately, it is unlikely to cause long-term illness, and it may respond well to antibiotic treatment. However, you also have to be mindful of coinfections — the Lone Star ticks that transmit STARI may also transmit a variety of other serious bacterial and viral infections.
As with any tick-borne illness, prevention is the best medicine. But taking steps to boost your body’s natural defenses by eating a nutritious diet, exercising, getting enough sleep, and consuming phytochemical-rich herbs, including Japanese knotweed, cat’s claw, andrographis, Chinese skullcap, reishi, cordyceps, and garlic, may also offer a layer of protection and support overall health before or after a tick bite.
Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme. You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.
1. Abdelmaseih R, Ashraf B, Abdelmasih R, Dunn S, Nasser H. Southern Tick-Associated Rash Illness: Florida’s Lyme Disease Variant. Cureus. 2021;13(5):e15306. Published 2021 May 28. doi:10.7759/cureus.15306
2. Lyme Disease. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/lyme-disease/symptoms-causes/syc-20374651
3. Lyme Disease Maps: Most Recent Year. Centers for Disease Control and Prevention website. https://www.cdc.gov/lyme/datasurveillance/maps-recent.html
4. Slide show: Guide to different tick species and the diseases they carry. Mayo Clinic website. https://www.mayoclinic.org/tick-species/sls-20147911?s=7
5. Southern Tick-Associated Rash Illness. Centers for Disease Control and Prevention website. https://www.cdc.gov/stari/index.html
6. Upstate tick expert predicts huge season for ticks. Upstate Medical University website. https://www.upstate.edu/news/articles/2022/2022-03-24-ticks.php
7. Wormser GP, Masters E, Liveris D, et al. Microbiologic evaluation of patients from Missouri with erythema migrans. Clin Infect Dis. 2005;40(3):423-428. doi:10.1086/427289